Are Doctors Listening?

A Hopkins professor's research on how communication problems between white doctors and African-American patients affected their care won her a MacArthur `genius' grant

Q&A -- Lisa Cooper

September 30, 2007|By Michael Hill | Michael Hill,Sun reporter

When Lisa Cooper was growing up in Liberia, she wanted to be a pediatrician.

"I saw a lot of little children who were poor and sick, and I felt that I didn't want to see children suffer, that I would become a doctor and take care of them," she says.

There was only one problem. While in medical school at the University of North Carolina, she discovered something: "I really didn't like pediatrics.

"I liked children, but I could not deal with sick children," she says. "I felt so bad for them that I just could not do it. I decided to deal with adults."

That decision worked out well. Last week, Cooper was awarded one of the so-called "genius" grants by the MacArthur Foundation, $500,000 to be used any way she chooses.

It was Cooper's pioneering work looking into how minority patients are treated differently by doctors that drew the attention of the foundation.

"I think I always knew at some level, just because of where I had grown up and what I had seen, that there were all sorts of things other than just coming to the doctor that impacted people's health," she says.

Cooper is the daughter of a prominent Liberian surgeon, the former chief medical officer of the John F. Kennedy Medical Center, a huge hospital in Monrovia, the capital of the country founded by freed American slaves in the send-them-back-to-Africa movement of the mid-19th century.

Among other things, her father was personal physician to the country's president, William Tolbert Jr., who was killed in a coup on April 12, 1980, led by an illiterate Army sergeant named Samuel Doe. Cabinet members were tied to a stake on the beach and executed in a drunken orgy of violence.

"It was awful, awful, awful, awful," she says of that day, her 17th birthday. "Everything was kind of turned upside down. I was about to graduate from high school, but I never even went to my graduation.

"If you would have told me at the time that I would be sitting here talking about getting this grant, I would not have believed you," Cooper says. "I thought I was going to die. I thought my whole family was going to die.

"My father was not a political figure, but he knew a lot of people, a lot of people in the Cabinet. These were people he had grown up with. So he was somebody who was targeted."

Cooper fled, heading to Emory University in Atlanta, the only United States school that had sent her an acceptance letter when the coup took place.

"I didn't have a choice," she says. "I had a letter from Emory and a student visa. But it worked out. It's a good school."

Her brother was already in the United States, and her sister and parents soon came to this country. Her father died four years later of a heart attack at 56.

Cooper, 44, lives in Columbia with her husband and teenage son. Her mother lives nearby. How did you come to get interested in the interaction between doctors and minority patients?

After medical school, I came to Johns Hopkins, to get a master's degree at the School of Public Health, thinking I would study international health and maybe go back to Africa. But Hopkins got me interested in doing research.

I found out if you want to make changes, one of the ways is by documenting what certain problems are. If you can provide data, people can use that to make decisions about how health care resources are spent and you can really make change that way. So I thought I would try my hand at that.

I started looking at some things I had noticed during my residency at the University of Maryland hospital in Baltimore. One of the things that struck me was some of the issues I saw in my African- American patients were similar to what I had seen growing up in Liberia.

There were things like cultural beliefs, such as that cancer would spread if you had it operated on, or that mental illness had a religious aspect, that it was an indication that your relationship with God was wrong.

What I began noticing was that doctors didn't understand their patients, their beliefs and why they were behaving in the way they were. A lot of times, you heard doctors making assumptions about minority patients - that they would not follow through on some treatment plan, so don't even bother, or they wouldn't understand something, so don't explain it. This wasn't done in a malicious way, per se, but it was done.

I thought this was having some sort of impact on people's health care, so I thought I would try to document what was going on. If you just talk about things anecdotally, people won't give much weight to it. But if you survey thousands of people, then they sit up and take notice. So how did you go about researching the issue?

First, I was able to add some questions to a national survey on depression, how it was being treated. A lot of people are just getting treated by their primary care physicians, but our treatment protocols are based on people in psychiatric hospitals. So, are we treating people right?